Workforce by staff group
The NHS1 in England currently employs around 1.4 million people (on a headcount basis, counting each individual member of staff) and 1.3 million on a full-time equivalent (FTE) basis. These figures include staff in ambulance, community, mental health and hospital services, as well as those in commissioning roles and central bodies like NHS England, making it the largest employer in England.
- 1There are many other staff groups who help provide NHS services but are not directly employed by the NHS. For example, there are nearly 144,000 FTE staff working in general practice and more than 24,000 dentists.
Change in workforce numbers over time
Since 2009, the number of NHS FTE staff has increased by more than 25 per cent. However, this growth has not been evenly spread across the years or staff groups. Changes to the workforce are set against the backdrop of several events, each associated with different trends. The 2008 economic crash saw a reduction in health workers, as NHS staff make up a large proportion of the NHS budget. The NHS re-organisation around 2010/11 led to high staff turnover with pay freezes and fewer managers, and most recently Covid-19 saw a sharper rise in workforce in response to the demands of the pandemic.
Change in staff groups over time
While overall FTE staff numbers have been growing, some staff groups have seen a decline in numbers or a decline in growth. Unmasking variation within staff groups shows that while adults and children’s nurses have increased since 2009, learning disability, mental health and community nursing have seen a loss of nearly 8,000 nurses. Although some medical specialties have struggled to recruit trainee doctors, the overall number of consultants has continued to increase.
Vacancies remain a big concern, with an estimated 112,000 posts currently unfilled substantively. Although the NHS workforce has been growing, demand for NHS services has been growing faster, and the health service hasn’t been able to recruit and retain enough staff to keep up. Although some substantive posts are filled temporarily by bank and agency staff, this can be costly to the NHS.
Reasons for leaving
Resolving NHS workforce shortages is about both recruitment of new staff and retention of existing staff. More than half of NHS leavers are voluntary resignations. These include reasons such as relocation or dependents, however the top two reasons are to improve work–life balance, or because of health issues. The number leaving for these reasons has more than doubled since 2013/14.
Staff satisfaction is important to ensure retention, and the NHS Staff Survey shows a concerning trend downwards. Only a quarter of staff are happy with their level of pay, or the level of staffing in their organisation, and a third state that they often think about leaving, all down from last year. There are also cultural problems, with nearly one in five staff reporting bullying or harassment from colleagues. The number who would recommend their organisation as a place to work fell from 67 per cent in 2020 to 57 per cent in 2022.
Despite an increase in the NHS workforce, there are not enough staff to match demand, as shown by the number waiting for care. Recruitment and retention are both problems, with high and growing vacancy rates, and low and falling staff satisfaction. It is to be hoped that the long-awaited workforce plan will tackle these problems.
Read more about the challenges facing the health and care workforce and some potential actions in our report.